| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
31,292 |
30,313 |
$882K |
| D0120 |
Periodic oral evaluation - established patient |
35,849 |
34,700 |
$671K |
| D1208 |
Topical application of fluoride, excluding varnish |
41,874 |
40,495 |
$611K |
| D1999 |
|
28,678 |
25,924 |
$543K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,848 |
2,732 |
$532K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,534 |
3,092 |
$358K |
| D0330 |
Panoramic radiographic image |
8,093 |
7,768 |
$341K |
| D0272 |
Bitewings - two radiographic images |
19,318 |
18,657 |
$328K |
| D1110 |
Prophylaxis - adult |
8,331 |
8,095 |
$308K |
| D1351 |
Sealant - per tooth |
12,527 |
3,577 |
$292K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12,298 |
11,018 |
$262K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,509 |
7,278 |
$195K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,258 |
2,038 |
$187K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,545 |
1,821 |
$160K |
| D0274 |
Bitewings - four radiographic images |
5,524 |
5,350 |
$122K |
| D0240 |
|
6,522 |
3,247 |
$112K |
| D0140 |
Limited oral evaluation - problem focused |
2,758 |
2,628 |
$77K |
| D1206 |
Topical application of fluoride varnish |
2,775 |
2,701 |
$67K |
| D0220 |
Intraoral - periapical first radiographic image |
3,021 |
2,907 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,900 |
696 |
$19K |
| D0145 |
Oral evaluation for a patient under three years of age |
750 |
712 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
33 |
26 |
$3K |
| D1510 |
|
13 |
12 |
$2K |
| D3120 |
|
33 |
26 |
$739.20 |